Hospital/Facility: Tenet Healthcare Corporation
Location: Dallas, TX
The Senior Director, Regional Operations, Florida and Pennsylvania reports directly to the Senior Vice President and Chief Managed Care Officer.
The Senior Director, Regional Operations, Florida and Pennsylvania is responsible for negotiating local Managed Care agreements with applicable health plans such as Independence Blue Cross, Florida Blue, Avmed, and other state-specific health plans. IBC and Florida Blue are two of Tenet’s 12 largest commercial health plans nationally and the Senior Director is charged with developing and maintaining strong relationships with the personnel at these health plans. The person in this position is also responsible for managing a couple of other Managed Care personnel, and handling all of the ongoing contract operational aspects of the job in terms of interfacing with hospital CEOs, CFOs, DBDs, and other hospital personnel, as well as regional leadership and home office staff. The Senior Director, Regional Operations also works closely with the Conifer team, Managed Care Legal and others to secure payment under our revenue cycle operational activities and leading settlement efforts on old, unpaid claims that need to be closed-out. Finally, the Regional Director is responsible for ensuring the development of and proper operations of our ACOs/CIOs in Florida and Pennsylvania.
In addition to regional Managed Care duties, the person in this position will also have responsibility for working with Tenet personnel nationwide on the development and geographic expansion of Tenet-owned health plans. This will include leading the roll-out of proprietary health plans, sourcing staff that will help manage the plans and serve as the primary contact on behalf of Tenet for joint venture health plans.
Specific challenges include:
· Negotiating and maintaining local Managed Care agreements with applicable health plans such as IBC and Florida Blue with commercial revenue in excess of $500 million annually.
· Building and maintaining relationships with health plan personnel to enable negotiating results.
· Working with regional Senior Vice President, Chief Financial Officer, Director of Business Development and others, as well as hospital A-Team members, to resolve managed care operational issues
· Overseeing and managing regional Managed Care Team members.
· Working closely with Conifer and others to secure appropriate payments under our contracts and setting up and obtaining settlements with health plans
· Managing the roll-out and expansion of Tenet-owned and joint venture health plans. Developing structure for managing the plans and identifying personnel for day-to-day management of the plans
The Senior Director, Regional Operations, Florida and Pennsylvania will work closely with Managed Care to develop strategies related to contract renewals with health plans and improve contractual operations/revenue cycle. He/she will team with Regional Leadership to develop financial projections and budgets; provide updates on negotiation(s) status; cultivate business development opportunities; drive proprietary health growth; promote ACO/CIO development and operations; and monitor status of managed care settlements. This individual teams with various Home Office Departments (Physician and Business Development; Legal; Clinical Quality/Medical Director; Human Resources; Corporate Finance; and Operations) to discuss operational aspects of contracts and renewal plans and strategies.
A Bachelor’s degree, preferably in Business Administration or Healthcare Finance, is required. A Master’s or other advanced degree is strongly preferred.
More than ten years of managed care experience. Deep and sophisticated experience leading the development of managed care strategies and ensuing negotiations for a major, respected payor organization.
Superior financial, marketing, reimbursement, healthcare planning and analytical skills and abilities, as necessary.
Thorough understanding of the current national managed care environment.
Demonstrated understanding of the current and potential future roles of providers, payors, employers, physician groups and patients in a continuously evolving managed care environment.
Possess a blend of line and staff experiences, with demonstrated skills in identifying and executing a strategic plan in a rapidly changing environment.
Experience developing pricing and risk strategies on the payor side.
Thorough and complete knowledge of the financial relationship among physicians, hospital and payors in a managed care setting.
Please apply at email@example.com